我院2008-2011年骨科和普外科手术患者创面感染病原菌的菌种及体外药敏分析

Analysis of Categories and Drug Sensitivity in vitro of Pathogenic Bacteria of Surgical Infection in Orthopedics Department and General Surgery Department of Our Hospital during 2008-2011

目的:分析外科手术患者创面伤口感染病原菌的种类及耐药状况。方法:采用手工及仪器鉴定菌种,采用纸片扩散(K-B)法进行药敏分析,对菌种特点及耐药性进行检测分析,对耐药表型进行检测。结果:在我院2008-2011年骨科和普外科送检标本382份中,共分离出病原菌菌株171株,阳性率为44.76%。其中革兰阴性杆菌92株,占53.80%;革兰阳性球菌71株,占41.52%;真菌8株,占4.68%。病原菌以大肠埃希菌、表皮葡萄球菌、溶血葡萄球菌、铜绿假单胞菌、粪肠球菌为主,分离率分别为31.58%、15.21%、14.04%、8.19%、7.02%。耐甲氧西林金黄色葡萄球菌(MRSA)检出率为73.77%,耐甲氧西林表皮葡萄球菌(MRSE)检出率为77.36%,氨基糖苷类高水平耐药的肠球菌(HLAR)检出率为78.26%。92株革兰阴性杆菌中产超广谱β-内酰胺酶(ESBLs)菌占38.68%,产AmpC酶菌占59.77%,产SSBL(同时产超广谱β-内酰胺酶和持续高产Ⅰ型β-内酰胺酶)菌占14.70%。结论:外科手术感染病原菌以革兰阴性杆菌为主,产酶率以及葡萄球菌属耐甲氧西林菌株数逐年上升,对常规药物表现出不同程度的耐药;应根据药敏试验结果选择抗菌药物,以减少耐药菌株的产生。

To analyze the types and drug resistance of pathogenic bacteria in surgical patients. METHODS： The samples of bacteria were identified by hand and instrument. The drug sensitivity tests were conducted by K-B paper diffusion. The characteristics and drug resistance of pathogenic bacteria were analyzed, and resistance phenotype was detected. RESULTS： Of total 382 of test samples in orthopedics department and general surgery department of our hospital during 2008-2011, 171 strains of pathogenic bacteria were isolated with positive rate of 44.76%, among which there were 92 Gram-negative bacilli （53.80%）, 71 Gram-positive bacteria （41.52%） and 8 fungus （4.68%）. The main pathogens were Escherchia coli, Staphylococcus epidermidis, Staphylococcus haemolyticus, Pseudomonas aeruginosa and Enterococcus faecalis, and isolation rate of them were 31.58% , 15.21%, 14.04%, 8.19% and 7.02% respectively. The isolating rate of methicillin-resistant Staphylococcus aureus （MRSA） was 73.77%, and that of methicillin-resistant S. epidermidis （MRSE） and high-level aminoglycoside-resistant Enterococci （HLAR） was 77.36 % and 78.26 %. Among 92 strains of Gram-negative bacilli, extended-spectrum producing β-lactamase （ESBLs） accounted for 38.68%, producing AmpC accounted for 59.77%, and producing SSBL （ESBLs and super-producing type Ⅰ β-lactamase） accounted for 14.70%. CONCLUSION： Gram-negative bacilli are the main pathogenic bacteria in surgical infection, and the rates of producing β-lactamase and methicillin-resistant Staphylococcus are increasing year by year. They show different degree of resistance to common drugs. The antibiotic should be selected according to the results of drug sensitivity test so as to reduce the drug-resistant strains.